Intracranial Administration of Nicardipine After Aneurysmal Subarachnoid Hemorrhage: A Review of the Literature

Vincent Dodson, Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, New Jersey, USA.
Neil Majmundar, Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, New Jersey, USA.Follow
Mohammad El-Ghanem, Department of Neurology and Medical Imaging, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.
Krishna Amuluru, Department of Neurointerventional Radiology, University of Pittsburgh, Hamot, Erie, Pennsylvania, USA.
Gaurav Gupta, Department of Neurology, Neurosurgery and Radiology, Rutgers University - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Rolla Nuoman, Department of Neurology, Rutgers University - New Jersey Medical School, Newark, New Jersey, USA.
John Wainwright, Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Gurmeen Kaur, Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Chad Cole, Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Justin Santarelli, Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Dipak Chandy, Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Christian Bowers, Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Chirag Gandhi, Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Fawaz Al-Mufti, Department of Neurology, Neurosurgery and Radiology, Rutgers University - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA. Electronic address: fawaz.al-mufti@wmchealth.org.

Document Type

Article

Abstract

BACKGROUND: Intrathecal (IT), intraventricular (IVt), and intracisternal administration of nicardipine deliver treatment directly into the central nervous system. This route of drug delivery is being investigated as a potential treatment of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE: The authors reviewed the existing literature regarding the direct administration of nicardipine into the intracranial space for the treatment of vasospasm following aSAH. METHODS: An electronic search of literature published between 1994 and 2018 was performed using PubMed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A variety of combinations of the search terms "intrathecal nicardipine," "intraventricular nicardipine," and "nicardipine prolonged-release" were used. RESULTS: A total of 17 studies were included in this systematic review, 3 of which were studies in animals. The studies consistently demonstrated that IT nicardipine successfully reverses vasospasm, but the effect, as shown in some studies, was limited to the immediate vicinity of drug release. The data regarding long-term clinical outcomes are variable, with some studies demonstrating marked improvement whereas others fail to demonstrate improved outcomes when compared with patients who receive standard of care. Although adverse sequalae were uncommon, IT and IVt administration and therapy were associated with adverse effects including headache, meningitis, and hydrocephalus. CONCLUSIONS: Given the findings presented in these studies, IT, IVt, and intracisternal (pellet) nicardipine administration can be useful treatment adjuncts for vasospasm following aSAH, especially in cases refractory to conventional forms of treatment. However, larger, controlled clinical trials are warranted.

Medical Subject Headings

Drug Implants; Female; Humans; Injections; Male; Nicardipine (administration & dosage); Subarachnoid Hemorrhage (drug therapy); Vasodilator Agents (administration & dosage); Vasospasm, Intracranial (drug therapy)

Publication Date

5-1-2019

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

125

First Page

511

Last Page

5.18E+03

PubMed ID

30708083

Digital Object Identifier (DOI)

10.1016/j.wneu.2019.01.103

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